Comorbidities and quality of life in outpatients with schizophrenia, depressive disorder, and generalized anxiety disorder: Project Cosmos. The cross-sectional results
Abstract
Aims: The aim of Cosmos project (COmorbiditieS in MOst Severe Neurology and Psychiatric Indications in the Czech Republic), an observational, multicenter, prospective study, is to survey the prevalence of comorbid mental and physical disorders and their impact on quality of life in patients with a selected primary diagnosis (schizophrenia - SCH), depressive disorder (MDD), generalized anxiety disorder (GAD) and neuropathic pain (NP) in outpatient care. These preliminary results pertain to data obtained from patients with primary mental disorder at the time of initial examination (cross-sectional results).
Methods: The data were collected by outpatient physicians, and besides the primary and comorbid disorders, demographic and clinical data, including current treatment and severity of the disease (CGI scale), were recorded. In addition, Quality of life (QoL) was self-assessed by patients using the Q-les-Q questionnaire (The Quality of Life Enjoyment and Satisfaction Questionnaire).
Results: One hundred and sixty-two physicians collected data from 2 266 patients (SCH - 744 patients (33 %), MDD - 896 patients (40 %), GAD - 626 patients (27 %). Comorbid mental disorders were found in 32 %, 49 %, and 48 % of patients with SCH, MDD, and GAD, respectively.
The most frequent comorbidies were substance use disorders, anxiety disorders, and personality disorders. Somatic comorbidities were identified with a frequency of 48 %, 59 %, and 54 % in SCH, MDD, and GAD, respectively.
Hypertension, obesity, thyroid illnesses and disorders of lipid and carbohydrate metabolism were the most common comorbidities. Patients with a depressive disorder rated QoL lower than patients with schizophrenia, and comparable to patients with generalized anxiety disorder.
In all groups, the presence of psychiatric, but not somatic comorbid condition was related to significantly worse QoL. Conclusion: Despite preliminary nature, the results demonstrate evidence of a substantial prevalence of comorbidities in patients with mental disorder in routine clinical practice, with accompanying negative impact on patients' lives.